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Contrast-Induced Encephalopathy: A Clinical Conundrum.

Arunava Saha1, Shari Mitra2

  • 1Internal Medicine, Saint Vincent Hospital, Worcester, USA.

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|December 16, 2022
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Summary

Contrast-induced encephalopathy (CIE) is a rare neurological complication. This case highlights CIE occurring after intravenous contrast administration, emphasizing the need for vigilance even with non-arterial routes.

Keywords:
adverse eventaltered sensoriumcontrast toxicityiv contrastmetabolic encephalopathy

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Area of Science:

  • Neurology
  • Radiology
  • Pharmacology

Background:

  • Contrast-induced encephalopathy (CIE) is a rare neurological complication typically associated with intra-arterial contrast media.
  • It results from disruption of the blood-brain barrier, leading to diverse neurological deficits.
  • Intravenous contrast administration is less commonly implicated.

Observation:

  • A case of CIE is presented in a woman in her mid-70s following intravenous contrast for a computed tomography pulmonary angiogram (CTPE).
  • The patient developed acute confusion and agitation shortly after receiving Isovue 370 (iopamidol).
  • Neurological examination revealed no focal deficits, and initial CT brain imaging showed no abnormalities.

Findings:

  • The patient's symptoms of confusion and disorientation resolved within 48 hours with conservative management, including IV fluids and blood pressure control.
  • This case represents one of the few reported instances of CIE following intravenous contrast administration.
  • While typically transient, CIE can present with variable symptoms and, rarely, persistent deficits or cerebral edema.

Implications:

  • This case underscores the importance of considering CIE even with intravenous contrast, particularly in patients with risk factors.
  • Prompt recognition and supportive care are crucial for favorable outcomes in CIE.
  • Further research may elucidate the mechanisms and risk factors for CIE following intravenous contrast administration.